Fertility tests are essential to reveal what is (or what isn’t) working, which can save a lot of time and stress for all couples trying to conceive. They really become a priority when:
- There are physical problems, such as an inability to ejaculate, or very irregular menstrual cycles
- The woman is 35 or older and hasn’t conceived after trying for at least six months
- The woman is under 35 but hasn’t conceived after trying for a year or more
- The man’s over 40, and the couple hasn’t conceived after trying for six months
Fertility tests vary from blood samples to abdominal surgery. Some results can bring up strong emotions, and partners may feel differently about them, so discussing in advance is a good idea. Up to 20% of infertility is classed as “unknown in origin”, so bear this in mind…
Initial fertility tests
| Who | Test name | Description |
|---|---|---|
| Both partners | Medical history | Review of medical sexual history, contraceptive methods, infections, medications, lifestyle, diet, exercise and any sexual issues |
| Both partners | BMI | The body mass index (BMI) affects hormone levels and can affect fertility |
| Woman | Physical exam | A woman’s physical includes a pelvic examination and ‘Pap test’ |
| Man | A man’s physical includes a testicular examination | |
| Ideally both partners | Blood tests | Luteinizing hormone (LH) |
| Progesterone | ||
| Thyroid function test (T4, T3, TSH) | ||
| Prolactin | ||
| Follicle Stimulating Hormone (FSH) | ||
| Testosterone | ||
| Anti–Mullerian Hormone (AMH) | ||
| Both partners | Swabs | For sexually transmitted infections (STI) |
| Man | Semen sample | A semen analysis checks semen quantity, sperm numbers, shape, movement, and if white blood cells are in the sample |
The information may suggest options on how to proceed:
- The tests show up an issue that rules out natural pregnancy, and an ART is the only option
- Results are inconclusive, and more tests are needed to assess the chances of a natural pregnancy
- Nothing is found, and the best advice is to continue trying in a more focused way for a while
- Raising natural fertility by following the advice for your personal fertility profile (PFP)
- To optimise your fertility by identifying problems with functional health tests
Further fertility tests for women
| Test name | Description |
|---|---|
| Pelvic ultrasound | To check the size and structure of the uterus, fallopian tubes & ovaries. Follicle growth and egg release can the “tracked” |
| Hystero-contrast sonography (HyCoSy) | An ultrasound adaptation that gives a better view of the womb & tubes |
| Hysterosalpingogram (HSG) | An X-ray of the womb and tubes can show tubal blocks & issues that prevent implantation |
| Laparoscopy | This gives a clear look into the pelvic cavity. Cysts, adhesions, fibroids, endometriosis & infections can sometimes be treated |
| Hysteroscopy | A ‘scope to check the womb. It can remove growths, unblock tubes & take biopsies |
| Endometrial biopsy | A small piece of the womb lining is removed for testing, or a “scratch” test is done |
Additional fertility tests
If the standards tests can’t a reason for infertility, or if infertility treatment has been unsuccessful, then one (or more) of the following tests may be suggested:
| Who | Test name | Description |
|---|---|---|
| Both | Antibody blood tests | There are antibodies (especially APAs) that reduce fertility (immune conditions) |
| Karyotype Test | To check for genetics that reduces fertility or increases miscarriage risk | |
| Man | Further sperm tests | To assess sperms ability to create a viable embryo (additional sperm tests) |
| Ultrasound | Ultrasound of the testes will show physical reasons for poor semen samples | |
| Woman | A repeat of uterine testing | In up to 1/4 of patients initially diagnosed as normal after a hysteroscopy or HSG, abnormal uterine structures are found after further examination. i |
Karyotype Test
The karyotype (or chromosome analysis) checks the structure, number and arrangement of chromosomes and their DNA code. The chromosomes are separated, processed and photographed to see if there are any missing or extra. It can find structural changes that cause miscarriage or genes that cause illness. It’s very similar to “amniocentesis” or “chorionic villus sampling” (CVS) testing in pregnancy that checks a baby’s health or sex but uses a blood sample.
Karyotype testing can reveal defective chromosomes carried by parents that could cause problems for their baby’s development or growth. Even if both partners are healthy, one might have genes that risk severe defects. Some genes are “recessive” (they’re carried but not ‘expressed’ in that person), and when both parents carry the recessive gene, there’s a high chance their children will be affected.
Miscarriage
Around 50% of pregnancy losses in the first trimester are due to genetic problems. Genetics may play a part for couples who experience repeated miscarriages without a known cause or who have unexplained infertility, and the only way to know is by testing. Both partners must test to get a complete picture as some rare genetic matches can prevent pregnancy. This includes HLA DQα genotype compatibility, where there’s an unfortunate and crucial co-incidence of matching genes.
Abnormal numbers of chromosomes “trisomy” cause genetic conditions such as Down’s syndrome; they increase in the eggs and sperm as people get older and cause most of the higher miscarriage and lower pregnancy rates experienced by older couples. The karyotype test can’t detect DNA fragmentation, but tests for this are available for sperm.
